So, I had a chance to read Dr. Marty Makary’s new book, which is called Blind Spots; and here’s why I wanted to get him to come back on Relentless Health Value and talk to you, people of the healthcare industry. It’s because of something that he said on page 127 and which I’ve been mulling over for probably years, actually. To Read The Full Article Including Links Mentioned, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. It’s this idea of what is appropriate care and how good are we at ensuring that patients/members get said appropriate care. Lots of people are of the same minds because appropriate care has come up in the show with Ben Schwartz, MD, MBA (EP434); John Lee, MD (EP438); Spencer Dorn, MD, MPH, MHA (EP446); Tom Lee, MD (EP445).  I mean, an estimated 21% of all medical care is potentially unnecessary. And unnecessary is, of course, one category of things that are not appropriate. This is according to a national survey of physicians: 25% of diagnostic tests, 22% of all medications, and 11% of all procedures are unnecessary/inappropriate. This is billions of wasted dollars doing stuff that shouldn’t be done, and it’s not appropriate care. But think about this: How many visions for how to fix healthcare and how to reduce waste depend upon a broad-stroke assumption that we will materially ensure that patients are getting best-practice (ie, appropriate) care? That we cut down on over-medicalization and surgeries on the back end and add appropriate preventative stuff and optimal medical therapy to the front end? Dr. Makary and I delve into the challenges of ensuring patients receive appropriate care, touching on medical dogma, financial, business, and legal incentives, and the importance of measuring practice patterns. Dr. Makary provides practical advice for clinical leaders, payers, and plan sponsors on promoting transparency, improving health literacy, and steering members towards higher performing providers. To Read The Full Article Including Links Mentioned, click here. 07:32 What is appropriate care? 10:19 Why what we think might be appropriate care might not be appropriate care. 10:34 Why is medical dogma damaging to appropriate care? 12:45 Why we need less absolutism in medical practice. 13:37 How is groupthink prevalent in medicine? 14:02 Why do we resist new ideas? 17:43 How do providers figure out what to believe and what not to believe? 20:59 “If you leave it to the medical profession to fix itself … so far, it’s not going well.” 22:33 How does supporting health literacy affect appropriate care? 30:23 “People need to find their care based on quality and price.” 34:28 What proportion of medical care is deemed unnecessary right now?  

In this conversation, Shawn Gremminger, a 340B program expert, shares why employers should pay attention to this crucial healthcare initiative. He explains how the program, designed for low-income Americans, unexpectedly impacts drug pricing for employers, leading to lost rebates and higher costs. Shawn dives into studies revealing market distortions caused by 340B entities and questions its effectiveness in assisting underserved communities. This episode emphasizes the need for employers to understand the financial risks associated with the 340B program.

Shawn Gremminger, a specialist in the 340B program, dives into its origins and evolution since its inception in 1992. He discusses the initial intentions of the program to help underserved communities, contrasting them with current outcomes. Gremminger raises critical questions about transparency and effectiveness, particularly regarding its impact on safety-net providers. The conversation highlights the financial strain on hospitals and the growing need for reform to ensure that 340B genuinely benefits those it was designed to help.

Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, dives into the complexities of value-based care. She discusses how the ideal intentions can be sidetracked by middlemen, causing inflated costs without delivering real value. Elizabeth advocates for transparent payment models that include prospective and bundled payments, urging cooperation among employers, employees, and primary care providers. Given the affordability crisis, she emphasizes the urgent need for innovative solutions to ensure genuine care that meets the needs of everyday Americans.

Will Shrank, MD, a venture partner at Andreessen Horowitz and former chief medical officer at CVS Health and Humana, discusses the shocking one trillion dollars wasted annually in U.S. healthcare. He highlights the need to align incentives with patient outcomes and the rising potential of primary care providers to combat this waste. The conversation delves into the evolution of value-based care, the challenges of the fee-for-service model, and innovative strategies to improve healthcare delivery and efficiency.

Dr. Amy Scanlan, a physician dedicated to integrating care, shares insights on the evolving landscape of healthcare. She highlights the financial and operational pressures facing doctors today and the necessity for strong teamwork in value-based care. Dr. Scanlan emphasizes the shift from traditional practices to collaborative care, discussing the importance of communication and real-time data in overcoming healthcare challenges. Her perspective reinforces the vital role physicians play in enhancing patient outcomes while adapting to a demanding environment.

Ashleigh Gunter, a healthcare messaging expert, dives into how effective communication can transform healthcare practices. She highlights a study showing that doctors respond better to patient-centric messaging, such as reminders about hand hygiene's impact on patient safety. Gunter discusses the importance of understanding healthcare professionals' motivations for initiating change and emphasizes that aligning change management strategies with organizational goals is crucial. Trust, strong leadership, and feedback are key elements for successful implementation.

Spencer Dorn, MD, MPH, MHA, is a medical professional dedicated to improving patient outcomes. He dives into the drawbacks of overly emphasizing technology, especially EHR systems, in healthcare discussions. The importance of context in technology evaluation is stressed, highlighting how human interaction shapes outcomes. Dorn encourages a nuanced approach, focusing on beneficial outcomes rather than the technology itself. The conversation challenges the conventional perceptions of healthcare tech, advocating for continual improvement while maintaining vital human connections.

Tom X. Lee, MD discusses the paradox of sustaining primary care practices independently. The podcast highlights the challenges faced by primary care entities in balancing revenue and high-cost services. Topics include the importance of enlightened leadership, value-based care, balancing financial incentives with societal impact, and recruiting dedicated doctors for long-term success.

In this encore episode of 'Relentlessly Seeking Value,' host Stacey Richter revisits a critically important conversation with ERISA attorney Paul Holmes about the complexities and hidden pitfalls in Pharmacy Benefit Manager (PBM) contracts. Aimed at CFOs and employer plan sponsors, Holmes highlights how poorly reviewed PBM contracts can lead to companies paying 30-40% over market for pharmacy benefits, discusses the potential legal exposures under the Consolidated Appropriations Act (CAA), and suggests the essential need for independent reviews. Holmes also delves into issues with Employee Benefit Consultants (EBCs) taking indirect compensation from PBMs and offers actionable advice for employers on how to mitigate these risks.  To read the full article, show notes as well as the links mentioned visit our episode page. While there, consider signing up for our free weekly newsletter.   07:41 What are Paul’s usual observations when a PBM contract crosses his desk? 08:34 “If you just sign … one of their model contracts …, you’re probably gonna pay 30% to 40% above market on your drug spend.” 12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 17:12 EP379 with AJ Loiacono. 17:40 Who is on the hook for the cost of the PBM contracts? 21:05 What’s the problem with most ERISA lawyers today? 22:56 Lawsuit about PBM contract. 27:43 What’s Paul’s advice for benefits consultants? 31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM?